Category Archives: Uncategorized

Noblesse Oblige

My Northwest Ohio federal and state senators and representatives, governor, with the lieutenant governor who is also the director of the insurance department, and the state Medicaid director.

We elected these people but King Moola rules.

Please can they throw us some crumbs.

Click on the crowns to read about my representatives. I’m deeply disappointed that they won’t fix the problems that are completely in their control to fix right now, like the highly inaccurate provider networks, and the transparency that the ACA provided for that they won’t abide by, and that they won’t pass an emergency “any willing provider” law so I can take my insurance dollars to my own doctor, and I’m shocked that when they say they are going to give us something better than the ACA, that they only think of the insurance industry, still putting profits over people. King Moola rules. Please, mini Moolas, please please throw us some crumbs!

If you are going to let yourself be crowned by the lobbyists, at least understand the concept of noblesse oblige. It’s like this: the masters must be responsible for those they tame.

The Price I Have to Pay

PG245180-Edit 2February 17, 2017

Lisa Iannotta
Office of the Ohio Attorney General
Collections Enforcement Section 150 E. Gay St.
Columbus, OH 43215

Dear Ms. Iannotta,

I reluctantly enclose a check for $10.05, the price I have to pay to get to see public records about provider network insurance complaints, only to find out that the Ohio Department of Insurance buries our complaints.

I resent having to pay anything to find out what a poor job the Ohio Department of Insurance is doing in regard to protecting Ohioans. The Ohio Department of Insurance should have to pay me, for all the time and trouble I had to go through, to learn the true fate of the complaints made by the citizens of Ohio, which is straight to the graveyard in the middle of the night.

The Ohio Department of Insurance should do their job, and that means they should clean up the provider network directories that Ohioans are complaining about, and not to make our complaints secret and delete them completely after only two years.

I resent that the Ohio Department of Insurance made this comment to the New York Times reporter, in the enclosed December 4, 2016 article in the New York Times, Insurers’ Flawed Directories Leave Patients Scrambling:

Enforcing [directory-accuracy rules] is “consumer-driven,” said David Hopcraft, a spokesman for the Ohio Insurance Department. The state does not check the lists until consumers report inaccuracies, one doctor at a time.

But the Ohio Department of Insurance doesn’t even do that much. The Ohio Department of Insurance makes provider network complaints confidential, shuffling them to a different office (the department undertaker) where they claim everything must be confidential by law. Then they bury them in secret — our provider network complaints are buried without a funeral or even a wake — we are never told what happened to our complaints, but we know for sure that they never saw the light of day.

Sincerely,

Penny Gentieu

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Penny Gentieu found many health insurance directories to be outdated and inaccurate.
Penny Gentieu found many health insurance directories to be outdated and inaccurate.

The Wild Wild West of American-style Pharmaceuticals

Pierre scans July 20160012

This is my great great grandfather’s photo of the Kickapoo Indian Medicine Company.

The Kickapoo Indian Medicine Company, of New Haven, Connecticut, sold “patent medicine” before they had patents for medicine. They sold snake oil when it was the cure-all. They weren’t really Indian. Kickapoo Medicine was often laced with alcohol, morphine, opium, or cocaine.

Fast forward to 2017. The shenanigans continue. Many mass market brand-name drugs that are nearing the end of their patent and even after the patent is over are being given orphan status. Orphan status allows the drug company to have a longer period of exclusivity on a drug and raise the price even higher than it was before.   Drugmakers Manipulate Orphan Drug Rules To Create Prized Monopolies     see also Orphan Drugs Lookup  new on Feb 10: Grassley launches inquiry into orphan drugs after KNH investigation

Meanwhile, generic drug manufacturers, taking advantage of patents that are no longer exclusive, have colluded with other drug manufacturers who make the same drug to raise their prices as much as 8,000%. A lawsuit is pending.   Alleged Scheme To Fix Generic Drug Prices Started At Dinners And ‘Girls Nights Out’

And now Trump wants to loosen regulations to encourage start-ups and get drugs to the market faster —  TRUMP’S PLAN FOR LOWERING BIG PHARMA DRUG PRICES COMES AT A HIGH COST

YEE-HAW!

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U.S. Congressman Jim Jordan’s ignorance and broken moral compass is not surprising

knowing that he’s a member of the “Freedom Caucus”

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John F. Kennedy would have cared. Pastel by my mother, Audrey Gentieu, 1964.

Congressmen are supposed to be concerned with the wellbeing of the people in the state to which they serve. But U.S. Representative Jim Jordan went out of his way to make uncaring comments on the report of Ohio’s highly inaccurate provider networks by Kaiser Health News and the New York Times, and how Ohio’s inaccuracies are the worst in the country, and that the state insurance department does nothing to fix the problem. (New York Times, December 4, 2016, Insurers’ Flawed Lists Send Patients Scrambling)

80% inaccuracies and people can’t find doctors. But here’s what U.S. Representative Jim Jordan, from Lima, Ohio, has to say. in a January 9, 2017  interview by Patient Daily.comFlawed ACA physicians’ lists are no surprise, Ohio congressman says

“It should surprise no one that the Ohio Department of Insurance’s physician directories are so flawed, considering how flawed the Affordable Care Act (ACA) is.”

“It’s sadly no surprise that the doctors’ lists were flawed as well,” Rep. James “Jim” Jordan (R-OH) said during a Patient Daily email interview. “Health care will be better and more affordable when Obamacare is gone.”

The Ohio Department of Insurance does not have physician directories, the insurance companies do, so Congressman Jim Jordan doesn’t know what he’s talking about. Yet he feels compelled to blame the ACA for it. The ACA has nothing whatsoever to do with the phony provider network directories of the health insurance companies that sell plans through the Marketplace.

U.S. Representative Jim Jordan’s ignorance notwithstanding, honestly, how can a U.S. Representative go on record saying that the 80% inaccuracies are not surprising? Has he no sense of right and wrong? Has he no empathy for his constituents and neighboring citizens of Ohio? 80% is a devastating percentage of a provider network to be found inaccurate. It happens to be the worse percentage of any survey yet reported from any state in the United States. Ohioans are hurting, and Rep. Jim Jordan is not helping!

Provider network directories are regulated by the state of Ohio and have existed long before Obamacare.  Most other states have accurate physician directories that people who are looking to buy insurance can use to properly assess the health insurance networks and find doctors who are accepting new patients like the list says. Many states have strict laws concerning the accuracy of their lists, and if the lists say they are accepting new patients, they are accepting new patients, and not just 20% of the list, as I have proven in Toledo.  Ohio does not have strict provider network directory laws and what little regulation the insurance companies have, is regulated by the Ohio Department of of Insurance, which is just like being regulated by the insurance company itself.

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The New York Times, December 4, 2016. Also published on Kaiser Health News.

Response to Findlay’s Mary Taylor article

The Courier, January 12, 2017   Lt. gov. says Obamacare not working

I’m sorry for Findlay losing their major insurer, Medical Mutual and their PPO. We lost them in Toledo too, in fact, all over the state, they are gone. It is a tragedy that Medical Mutual has been allowed to withdraw their long-standing PPO from the individual market, the only insurance they ever offered Ohioans before 2016, and they have been Ohio’s largest insurer since 1934. This is discrimination against a whole class of people, since Medical Mutual still insures Ohio state workers and corporate employees with their PPO, but they no longer offer individuals “real insurance”.  Why was there no public forum about this? No fanfare, no articles by Ohio health journalists, no consumer complaints (like mine) made public by the Ohio Department of Insurance while they let Medical Mutual insanely raise their rates throughout 2014, 2015, and 2016, just to eliminate their PPOs in 2017.

My Medical Mutual premium went up 224% in 2014 when it went on the Marketplace, and double-digits in 2015 and 2016. It wasn’t the health mandates that caused the rate hikes, that Mary Taylor tries to make a big deal of, because Medical Mutual already covered all of that. When I complained to the Ohio Department of Insurance about the crazy rate hike of 224% in the first year, they answered my complaint by giving me Medical Mutual’s answer —  that the Ohio Department of Insurance approved the rate hike so of course it must be okay. Isn’t it cozy how they’ve got each other’s backs?

I wonder how to take Mary Taylor’s statement in this article that insurance went up 91% on average in four years when mine went up 224% in just one year! If she is saying that premiums going up on average 91% in four years is bad, then how could she have ever approved of Medical Mutual’s rate hike of 224% in just one year? And why wasn’t my complaint properly addressed by her? If it had been, then maybe the individual insurance market wouldn’t be compromised today by Medical Mutual’s discrimination against us by the withdrawal of PPOs sold to self-employed Ohioans. She did all she could to usher in this crime against the individual, all in the name of some diabolical political agenda to deny healthcare to the American people.

In 2016, Ohio had the highest premiums after tax credits.  Mary Taylor has assured the failure of the ACA in Ohio in a number of ways. The CMS gave millions of dollars to States to enable “effective rate review.” Our money was used for something else because we never had effective rate review. Effective rate review would have allowed for public forums and open discussions about health insurance prices and problems. Instead, Mary Taylor rubber-stamped any and all rate hikes while keeping the facts far far away from the public. In Ohio, they like us dumb and ignorant.

Mary Taylor allows insurers to maintain provider networks that are on average 80% inaccurate, especially in Toledo where I surveyed them all. What is health insurance if not the provider network? How can insurance regulators allow such extreme dishonesty from our insurers? Why aren’t they looking out for us?

So now with the elimination of Medical Mutual’s PPO, and the total acceptance by Ohio that these new narrow provider networks, that are 80% lies, are just fine, Mary Taylor has the individual market neatly pushed aside as we get slowly snuffed out. We are artists, writers, musicians, inventors, shop owners, entrepreneurs, professionals, and hard-working breadwinners working multiple jobs. And now all of a sudden, we have to choose between having access to great healthcare, like our neighbors who work for the state and corporations, or maybe no healthcare at all, health being something we have to compromise in order to pursue our American Dream?

And what now, does Ohio dream for us? Back to the old, that’s what they want, but at really high prices that the last few years has brought us. Everyone with pre-existing conditions gets thrown under the bus. That would be 25% of us, and the majority would be the older ones my age. Gee thanks, I can’t wait to make it to Medicare age, as the joy of my perky young 60’s instantly taken away.

In Mary Taylor’s glee for dysfunction, the Ohio Department of Insurance laid the perfect backdrop for insurance and hospital hikes and mergers. On their watch, generic drug manufacturers colluded on the price of generic drugs raising prices as much as 8,000%.

And all Mary Taylor can say is, the old laws are in place to fall back on. Regression, regression, regression.

Patient Daily interview

I was interviewed by Patient Daily in regard to the Dec. 4 New York Times article, Insurers’ Flawed Lists Leave Patients Scrambling, specifically about the nitty gritty we face in Ohio with inaccurate provider network directories, the causes and the solutions.

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Patient Daily, December 30, 2016 — Critic claims Ohio doesn’t verify health care provider directory, by Karen Kidd
 "The quote in the New York Times article was shocking," Penny Gentieu, whose odyssey to find health insurance in 2017 involved contacting 308 physicians in six insurance plans, said in an email to Patient Daily. "That the Ohio Department of Insurance (ODI) said that enforcing the directory accuracy rules is consumer-driven by the public complaints of inaccuracies, one at time."
"Things are so bad in Ohio that the legislature last year allowed the Ohio Department of Insurance to write their own rules about how they handle provider network complaints," Gentieu said. "So-called health-watch people in the know objected, but the ODI wrote in a rule that allowed themselves to make entirely confidential any investigation they had about inaccurate provider networks. Which means that not even the people who complained, let alone the public, ever get to know anything about anything they do or don't do to the insurers in regard to their inaccurate provider network directories. Not only do they not do anything, they completely delete the complaints after two years. It's so crazy!"
"The Ohio legislature is controlled by the very rich and powerful insurance and pharmaceutical lobby industry," she said. "They have meetings, lunches and seminars with the legislators that constituents are not invited to and, consequently, the public's issues are never brought to light because we are way-overshadowed by the big money of health insurance and pharmaceuticals. What the legislators know about health insurance is strictly one-sided."
 If state legislators really wanted to do something about this problem, they would make laws with stiff penalties, Gentieu said.
"They would make complaints searchable on the ODI website. They would set up a truly 'effective rate review' annually, with public forums so we have a voice about this extremely terrible problem with health insurance that we face."
"Ohioans have to look under every rock, they have to anticipate any problem, because even though their premiums may have gone up 373 percent -- like mine went up in seven years -- they may only be getting 20 percent of the purported value of the plan."
"Congress should eliminate provider networks, make prices transparent, and take the control out of the hands of the health insurance and pharmaceutical company lobbyists."
"All the doctors should take all the insurance plans. Doctors are either accepting new patients or not. Doctors should not be allowed to lend their names to these plans as if just to beef up the provider network lists to give the insurance plans an illusion of adequacy, when in fact their name listed as accepting new patients when they are not accepting new patients is a total lie. It's false advertising."
"We are small business owners, entrepreneurs, shop owners, artists, writers, musicians and hard-working breadwinners working multiple jobs, " she said. “All of a sudden we have to balance our personal drive and ambitions to our ability to access the best in health care that those working for the government and large corporations are entitled to. It sort of takes down the American Dream, not only for us, but for young people considering their options and people who have a dream but are trapped in their jobs because they provide health insurance."

OAHP Lobbying Luncheon

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I was invited to attend today’s October 19 OAHP Health Insurance “Lunch and Learn” luncheon by my state representative, Rep. Fedor. It is a luncheon and presentation for all state legislative aids and guests. This is the business card I designed for it.  At 4:00 yesterday afternoon, they emailed me to tell me that the luncheon had been cancelled.

I didn’t realize before I accepted the invitation, but it was being presented by the big  health insurance lobbying group, the Ohio Association of Health Plans.  I looked at their website, and the trustees include five insurance companies that I contacted with my September 9 letter in which I asked them to fix their inaccurate provider network directories before Open Enrollment starts on November 1. In fact, three of the names were the same company officials to whom I addressed my letters, and they have yet to reply. It makes me sick that the insurance companies that won’t correct their provider network directories are so cozy with our lawmakers in Ohio, and nothing at all puts consumers on equal footing with the health insurance lobbying industry.

What a vivid example of modern democracy in action. Our legislative department gets wined and dined and legislators are given campaign contributions. Insurance companies dictate the laws in Ohio – look here at all of their “advice” to the Ohio Department of Insurance about the new provider network directory law Ohio made for 2016, that is totally one-sided and totally inadequate for the citizens of Ohio – you can see that it was written by the health insurance industry. How convenient that in Ohio, insurance companies are allowed to make the regulations that govern their business – regulations that are supposed to be made to protect consumers!  Why don’t WE have a voice?

Insurance companies have the power to influence, and in Columbus, the insurance companies hobnob daily with the legislative departments of our state.  What can the ordinary citizen do? Make a website? Send letters until our fingers are numb? Our letters are rarely even read, let alone considered. There is no fairness here. We are at the mercy of the healthcare industry. We will forever have completely bogus provider network directories.

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And would you look at all those pharmaceutical companies lobbying our state legislators too!

Related: Letter to the Health Policy Institute of Ohio

Letter to the Health Policy Institute of Ohio

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My letter today to Health Policy Institute of Ohio:

Dear Amy,

I’m reading your new publication about health insurance in Ohio. It has a lot of good information, but I see nothing for the consumers of Ohio, i.e., about effective rate review. We have no transparency in this state, and that must be why we have the highest premiums after tax credit than any other state. We also have a low median household income compared to other states, and in Toledo, it went down 17.4% in 10 years. Not that that should make any difference at all to the price of health insurance or healthcare for Ohioans, healthcare that we receive locally, in our poor local economy. If we had effective rate review in this state, you’d be hearing the consumer voices in public forums. And maybe it’s about time?

We have serious problems that I wish an independent, nonpartisan, statewide center like yours could analyze and report to policymakers, state agencies, the media, and the public. I see that your reports are reviewed by a lawyer who represents insurance companies. I don’t think it serves the people of Ohio very well, when an insurance company lawyer is involved in what you give to policymakers. Shouldn’t a consumer voice be somewhere in your report?

Here are the problems that I see, and nothing gets done (because obviously the insurance companies run everything and everyone).

1. Provider network directories are absolutely bogus, as I have proven in my survey of all of the family practice and internal medicine PCP doctors in Toledo, on the individual market health insurance plans. An average of 80% of the doctors across the plans, who are listed as accepting new patients, are not accepting new patients when you call them! I did! I called 308 doctors and my results are here: http://ohiocitizenratereview.info/

2. Complaints about provider networks to the Ohio Department of Insurance get buried. They become classified as confidential, and nothing ever gets done. I know, I made two complaints, and nothing got done to change the inaccurate directories! A report of the 30% increase in provider network complaints in 2014 would have been helpful, and to know the number of complaints in 2015 as well.

See, here: http://ohiocitizenratereview.info/provider-network-complaints-get-buried/ , http://ohiocitizenratereview.info/letter-complaint-examiner/,http://ohiocitizenratereview.info/rate-reviews/caresource-2017-rate-review/

3. Now the people in the individual health insurance market do not even have the option to buy PPOs anymore — we can only buy HMOs with extremely narrow networks that are made five times narrower by the lying, bogus, misleading, extremely inaccurate network directories. So what, someone might think, that 6% of the Ohio population can’t find a doctor? It’s only 6%! But let me show you how that hurts everyone — all 11.6 million people in Ohio. It locks people into their jobs, so they feel trapped by the need for decent health insurance, so they don’t test their brilliance to go out on their own, because there is no good insurance to buy if you are an individual; you can only work for a company or for the state to be privileged enough to have a PPO health insurance plan. After all, good insurance is for the privileged only. HMOs (with really bad inaccuracies, to boot) are what you get if you are an individual, even though just three years ago, 82% of the individual market was comprised of PPO health insurance plans. It’s discrimination. Who is ever going to want to be an individual, when individuals are flat-out discriminated against? Martin Luther King Jr’s famous quote has a whole new meaning now, with Medical Mutual removing PPOs from the individual market in Ohio: “Of all the forms of inequality, injustice in health care is the most shocking and inhumane.” Discrimination against the poor, this is what we think of when we think of that quote, but it is also discrimination against the geniuses, who perhaps do not want to give up their intellectual property to work for a corporation just to receive a superior health insurance plan that is now only possible to have when you work for the man (or for the state.) It’s not going to help the advancement of society to give it all up to the corporations. America is about freedom — life, liberty, and the pursuit of happiness. I don’t think that means we have to sacrifice equality in healthcare to pursue our American Dream. Please see my latest post: http://ohiocitizenratereview.info/brief-history-health-insurance/

4. We need transparency in this state. Consumer complaints should be made public in a database on a website that is consumer-oriented, and the Ohio Department of Insurance should start looking at how other states are doing it, because even though we are securely in the Midwest, you would think we lived in Russia, by the looks and feel of the Ohio Department of Insurance. http://ohiocitizenratereview.info/outrageous-health-insurance-rate-increases/if-other-states-can-do-it-why-cant-we/ http://ohiocitizenratereview.info/outrageous-health-insurance-rate-increases/database-of-consumer-complaints/http://ohiocitizenratereview.info/outrageous-health-insurance-rate-increases/rate-review-for-dummies/

5. Why don’t you report on the second lowest cost silver plan SLCSP discrepancy, where in the big cities in Ohio, the tax credit SLCSP is not the same as the second lowest cost silver plan SLCSP one has the option of buying — it doesn’t exist in the big cites and Ohioans are losing millions of dollars of promised tax credits. This is one big reason why Ohio is the most expensive state on the marketplace for health insurance premiums — we are losing out on both ends. see,http://ohiocitizenratereview.info/outrageous-health-insurance-rate-increases/slcsp-discrepancies/, http://ohiocitizenratereview.info/rate-reviews/buckeye-ambetter-2017-rate-review/

I can see how none of this would be discussed in your Health Insurance Basics, since it was reviewed by an insurance lawyer who represents insurance companies. An insurance lawyer? Really? I wish you could be more of a voice for the consumer, because the balance in Ohio is certainly skewed.

Sincerely